Provider Demographics
NPI:1295517910
Name:MCNULTY, BRODY (RPH)
Entity type:Individual
Prefix:
First Name:BRODY
Middle Name:
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BRODBELT LN APT 120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2456
Mailing Address - Country:US
Mailing Address - Phone:740-605-3353
Mailing Address - Fax:
Practice Address - Street 1:6266 GENDER RD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-2042
Practice Address - Country:US
Practice Address - Phone:614-920-0287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist